We undertook a focused inspection of Enslin Limited on 18 March 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a dental specialist advisor.

We undertook a comprehensive inspection of the practice on the 19 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well-led care and was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for dental practice on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

As part of this inspection we asked:

• Is it well-led?

Background

Enslin Limited Dental Care is a small, well-established dental practice that provides NHS treatment to about 10,000 adults and children. The dental team includes two dentists, three dental nurses, one receptionist and a practice manager. The practice has two treatment rooms.

As the practice is not on ground level, there is no access for people who use wheelchairs. The practice does not have its own parking facilities, but there is on street parking nearby.

The practice is open from 8:45 am to 5 pm each day.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at the practice is the principal dentist.

During the inspection we spoke with the principal dentist and the practice manager. We looked at practice policies and procedures, and other records about how the service is managed.

Our findings were:

• The provider had made good improvements in relation to the regulatory breach we found at our previous inspection and was now providing well-led care in accordance with the relevant regulations.

We carried out this announced inspection on 19 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

Enslin Limited Dental Care is a small, well-established dental practice that provides NHS treatment to about 10,000 adults and children. The dental team includes two dentists, three dental nurses, one receptionist and a practice manager. The practice has two treatment rooms.

As the practice is not on ground level, there is no access for people who use wheelchairs. The practice does not have its own parking facilities, but there is pay and display parking nearby.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at the practice is the principal dentist.

On the day of inspection, we collected 38 CQC comment cards filled in by patients and spoke with three other patients.

During the inspection we spoke with two dentists, two dental nurses, and the practice manager.

The practice is open: Monday to Friday from 8:45 am to 5 pm each day.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive view of a caring and professional service.

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, apart from portable suction.

• Members of the dental team were up-to-date with their continuing professional development and supported to meet the requirements of their professional registration.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted upon.

• Systems to ensure the safe recruitment of staff were insufficiently robust, as essential pre-employment checks had not been completed.

• Patients’ needs were not always assessed or treatment delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

A full detail of the regulation the provider was not meeting is at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.

• Review the practice's protocols for the selection criteria of radiographs taking into account the guidance provided by the Faculty of General Dental Practice.

• Review the practice's responsibilities to the needs of people with a disability, including those with hearing difficulties within the requirements of the Equality Act 2010.

During our visit to Enslin dental practice we spoke with people using the service and members of staff. We observed how people were treated by staff when booking in for their appointments and how they were greeted by the dentist and led into the surgery.

One person told us "I have been coming to the surgery for eighteen months and have never had any concerns."